Although guided high mechanical index (MI) impulses from a diagnostic ultrasound transducer have been used in pre-clinical studies to dissolve coronary arterial and microvascular thrombi in the presence of intravenously infused microbubbles, it is possible that a longer pulse duration (PD) than that used for diagnostic imaging may further improve the effectiveness of this approach. Using an established in vitro model flow system, a total of 90 occlusive porcine arterial thrombi (thrombus age 3–4 hours) within a vascular mimicking system were randomized to 10 minute treatments with two different PD (5 μsec and 20 μsec) using a Philips S5-1 transducer (1.6 Megahertz center frequency) at a range of MI’s (from 0.2 to 1.4). All impulses were delivered in an intermittent fashion to permit microbubble replenishment within the thrombosed vessel. Diluted lipid-encapsulated microbubbles (0.5% Definity®) were infused during the entire treatment period. A tissue mimicking phantom of 5 cm thickness was placed between the transducer and thrombosed vessel to mimic transthoracic attenuation. Two 20 MHz passive cavitation detection systems (PCDs) were placed confocal to the insonified vessel to assess for inertial cavitational activity. Percentage thrombus dissolution (% TD) was calculated by weighing the thrombi before and after each treatment. %TD was significantly higher with a 20 μsec PD already at the 0.2 and 0.4 MI therapeutic impulses (54±12% vs. 33±17% and 54±22% vs. 34±17%, p<0.05 compared to 5 μsec PD group, respectively), and where PCD’s detected only low intensities of inertial cavitation. At higher MI settings and 20 μsec PD, %TD decreased most likely from high intensity cavitation shielding of the thrombus. Slightly prolonging the PD on a diagnostic transducer improves the degree of sonothrombolysis that can be achieved without fibrinolytic agents at a lower mechanical index.

Introduction: The ring enhancing lesions of the brain are a challenging group of lesions with the variable possibilities of diagnosis under conventional Magnetic Resonance Imaging (MRI). Employing advanced techniques such as Magnetic Resonance Spectroscopy (MRS) could increase the success rates of the diagnosis. Aim: To assess the role of MRS in evaluating varying ring enhancing lesions of the brain. Materials and Methods: This prospective observational study involved 50 patients aged between 3-82 years who were detected with ring enhancing lesions of the brain on contrast MR studies. The patients underwent MRS evaluation. Categorical data was represented as frequency (%). The metabolite peaks of choline, lipid, lactate, N-Acetyl Aspartate (NAA), succinate and amino acids were recorded. The choline/creatine ratio was calculated and associated with the type of lesion the patients exhibited. Results: Among the 50 patients screened, the most prevalent pathologies were tuberculoma (36%) and neurocysticercosis (22%). While the patients diagnosed with tuberculoma presented with higher peak level of lipids and choline/creatine ratio of >1-2. Increased lactate, succinate, choline peak concomitant with no or insignificant lipid peak, were noted in the cases of neurocysticercosis. Primary brain tumour showed high choline peaks and elevated choline/creatine ratio (>2). Metastasis showed increased choline peak. Cerebral abscess showed increased amino acids and lactate peak. Conclusion: The diagnosis of varying ring enhancing lesions of the brain was accurately investigated by MRS. This accuracy enables delineating a treatment plan void of any dilemma.

Background: Stroke is one of the most common debilitating diseases with a huge burden related to both mortality and morbidity. Ischemic stroke is far common compared to haemorrhagic stroke and it is also associated with significant carotid stenosis. Hence this present study is carried out to evaluate all the aspects of this disease.Objectives: To Evaluate stroke and TIA patients with carotid ultrasound Doppler to look for Intima Media thickness, presence of plaque and characterization of plaque (type, surface and site), spectral waveform analysis and percentage of stenosis. To find out the prevalence of carotid artery stenosis in stroke patients and TIA patients. Observation/Correlation between percentage stenosis (carotid USG) and infarct size on CT. To find out if there is any association between carotid artery lumen IMT and stenosis with age, hypertension and diabetes. Design: Cross sectional single centre study. CT-scan and Carotid Doppler studies on patients admitted into our institution with signs and symptoms of stroke. A detailed and thorough history, physical examination and investigations were performed, studied and noted.Results: Out of 75 patients who are clinically diagnosed to have stroke, 55 patients showed small infarcts and 20 showed large infarcts in the CT-Scan. 75 patients

Aim:To assess the role of ultrasound (US) in assessing rotator cuff (RC) tears and to enumerate the associated findings.

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